Getting a patient to perform their home exercise program consistently has always been a concern of a physical therapist. As a health professional we know how crucial the home program can be. With a finite amount of directed and supervised exercise time in the clinic only so much progression can occur. It just makes sense that therapeutic intervention outside the clinic can make a significant difference. And so the big question has always been “What can a physical therapist do to ensure the best possible adherence and follow through of a home program by the patient?” Following are five key guidelines that can be done to improve compliance.
- Keep the program simple and brief. Patients are people, and as such have lives and often busy schedules outside of therapy. Give a program that can be done in a reasonable amount of time, for instance ten to fifteen minutes. This means about 3-5 exercises (which includes rest periods) Most people can squeeze in ten or fifteen minutes a day for an extra item on their daily schedule. Sure, it would be great if they could spend an hour, twice a day to dedicate to their rehabilitation, but giving a program of that length will likely result in it never even getting started. Pick your battles carefully. Would you rather have your patient do their program 15 minutes a day or be entirely overwhelmed by a program with 20 exercises, requiring 60 minutes, that never gets done?
- Provide periodic updates to maintain interest. Will the same quad stretch or abdominal crunch work the entire term of the rehab? Probably. But doing the same exercises over and over creates boredom. And boredom leads to decreased participation. The physical therapist has a vast number of exercises in their repertoire that can provide the same end result, so why not use them to create variety and interest while achieving the same goals? Plus providing periodic changes in the program creates a great opportunity to get feedback and follow up with the patient.
- Provide concise instructions and proper training. Does the patient get taught the right way to do the exercises in the clinic before being sent home with their program? Of course. Do they get told how many sets and reps and how long to rest? Of course. Will they remember all those details in 2 days? Probably not. And a patient not sure of what to do will likely not do the program, either from insecurity of doing something wrong or fear of potentially hurting themselves or making things worse. It is crucial to provide them with a clear set of instructions, illustrations and detailed parameters. Many home program software systems will do this. But it is surprising how many patients get sent home with just a simple stick figure drawing and no other information.
- Provide the instructions in a format the patient can understand. This concept is very similar to the above mentioned guideline. A professional health provider should be equipped with the proper tools to do their job effectively. Will a printed handout with instructions and line art diagrams or photos work for your patient? Or would they prefer to see video clips? There are software systems that can do either or both. It is up to the therapist to determine what tool would work best for them and their patients.
- Make a home program that consists of exercises that decrease symptoms and increase deficits. While all the above guidelines are important, this is the most crucial. Patients come to physical therapy to get better. Typically they define better (whether consciously or subconsciously) as less pain and improved function. It is almost a guarantee that if the patient is given three to five exercises to do at home and they do them for instance, for a week, and they see no decrease in their symptoms (pain, stiffness, sleeplessness, etc.) or no improvement in their function (better range of motion, less limp, no gain in strength, etc.), that patient is not going to continue with that program. If you learn nothing more than this from this blog, remember this and apply it to your home programs: “A patient who performs an exercise that helps decrease their symptoms or improves their function will always continue to do that exercise with no prodding from the therapist.”
So keep in mind these five principles when creating home programs for your patients. Simplicity, variety, clear instruction, appropriate format, and make the exercises do what the patient needs.